Diagnosis and assessment of chronic cough in children – a brief guide and clinical algorithm for primary care

This resource, “Diagnosis and assessment of chronic cough in children – a brief guide and clinical algorithm’ developed by Lung Foundation Australia, is a practical, evidence-based guide designed to assist primary care providers in assessing, diagnosing, and managing chronic cough in children. A chronic cough in children is defined as a daily cough lasting more than four weeks and is often a sign of an underlying condition that requires further investigation. This fact sheet outlines a clinical algorithm to guide history-taking, physical examination, and first-line investigations including chest X-ray and spirometry, where possible. The fact sheet distinguishes between wet and dry cough types, helping clinicians determine likely causes such as protracted bacterial bronchitis (PBB), asthma, post-infectious cough, pertussis, and more serious conditions like bronchiectasis, tuberculosis, and congenital airway abnormalities.

Protracted bacterial bronchitis is a key focus of the resource, identified by a wet, productive cough lasting over four weeks. Treatment with a two-week course of antibiotics, usually amoxicillin-clavulanate, is recommended, with a possible extension if symptoms persist. For children experiencing more than three episodes of PBB per year, referral to a specialist is advised. The resource also highlights important red flag symptoms that require urgent investigation, such as recurrent pneumonia, haemoptysis, feeding difficulties, systemic symptoms, and abnormal imaging or lung function results.

The fact sheet encourages a holistic approach, including addressing environmental exposures such as tobacco smoke, minimising unnecessary medications, and supporting families through reassurance and review-based strategies. It also offers culturally sensitive guidance for working with Aboriginal and Torres Strait Islander families, recognising their elevated risk for chronic cough. Treatment recommendations are backed by varying levels of evidence and strength of guidance, helping clinicians tailor management plans for both specific conditions and non-specific or refractory coughs. This evidence-based resource co-designed with clinicians supports early intervention and improved long-term respiratory outcomes for children.